To the Editor.—A recent editorial in the Archives (102:88, 1971), "The Dumping Syndrome," raised important issues.
It referred to an insignificant 1% of incapacitated patients as the result of gastrectomy. Its true significance lies in the concern of the surgical world with this and similar problems for close to 100 years.
One reads, "Rapid emptying... should be prevented by leaving an adequate gastric reservoir and creating a small stoma." Physiologic adequacy in ulcer surgery has come to mean resection of the acid-secreting surface which leaves a pouch of 25% to 30% capacity, approximately. The impression is conveyed that the stoma has a sphincteral action, but the modus operandi is not revealed.
Why should "Remedial surgery... be reserved for those rare patients who are incapacitated and unable to maintain their weight"? If this brings promise of improvement or cure, why not apply it at initial surgery for avoiding weight